MEDICARE: MS. ANA REYES RETANA DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	22930	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	22930	OTHER	TX	TEXAS LICENSE

General Provider Information

NPI Number	:	1952315038
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANA REYES RETANA DDS

Provider Business Mailing Address
First Line	:	14855 BLANCO RD STE 413
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78216-7731
Country	:	US
Telephone Number	:	210-884-7805
Fax Number	:	210-408-6001

Provider Business Practice Location Address
First Line	:	14855 BLANCO RD STE 413
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78216-7731
Country	:	US
Telephone Number	:	210-884-7805
Fax Number	:	210-408-6001

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	03/18/2011

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